Hemostat-retractor



April 8, 1958 R. J. GLENNER HEMOSTAT RETRACTOR' 2 Sheets-Sheet l FiledJan.. 1'7, 1956 INVENTOR. 7800527 4/. GLEN/v5:

April 8, 1958 R. J. GLENNER 2,329,549

' HEMOSTAT RETRACTOR Filed Jan. 17, 1956 2 Sheets-Sheet 2,

IN VEN TOR. 205527 J? zi/y/yiz Jrme/vsz HEMOSTAT-RE'I'RACTOR Robert J.Glenner, Chicago, Ill. Application January 17, 1956, Serial No. 559,660

4 Claims. (Cl. 128-425) The present invention relates to obstetrical andgynecological instruments utilized primarily by obstetricians, andconcerns itself particularly with vaginal retractors which will preventblood loss in episiotomy.

The birth of a child is accomplished through three recognized stages oflabor during which there is usually required the aid of a skilleddelivery technician. The first of these stages is a period during whichthe patient begins to have frequent and severe labor pains and duringwhich the expulsive spasms set in. The patient is then prepared for thedelivery and examined for adaptability to normal delivery.

The second stage is said to begin when the uterine cervix is completelydilated and when the patient experiences bearing-down pains. Thisusually requires 'the placement of the patient into recumbent position.At this time the child descends into the pelvic cavity producing anincreasing dilitation of the vulva. The distention of the vulva may bemost marked .at its perineal margin, and in order to prevent rupture ofthe perineum which when such probability is indicated would resultin anirregular tear and dimcult to arrest blood loss, the attending surgeonperforms an episiotomy along a median, lateral, or at a medio-lateralline, thereby enlarging the vulval opening and relieving pressurefromthe perineum.

From the conclusion of this performance until the proper time arrivesfor sewingup the episiotomy incision, there may ensue a time lapse ofone or more hours, depending upon the completion of the third stage oflabor as well :as upon the time required to inspect and repair possiblelacerations and tears such as arelikely to occur during the passage ofthe child through :the birth canal. Meanwhile, the site of theepisiotomy section requires to be traversed during expectancy andcompletion of the third stage, increasing thereby the hazards incidentto blood loss and infection.

It is therefore a primary object of this invention to provide anobstetrical instrument of reaction suitable for use over the site of anepisiotomy which will possess greater characteristics of self-retentionthereat and at the same time prevent or retard by compressive hemostasiscontinued "blood loss during the time of awaiting completion of thethird stage of labor and until final repairs to the cervix and vaginaare completed.

Another object of this invention is to provide an ins-trument of theclass described which will lodge securely over the site of an episiotomyincision without imparing access to the vulvular canal for the executionof uterine or vaginal wall repair.

Yet another object of the invention is to provide an instrument of theclass described having an insert portion which constitutes a substantialpreponderance of its total weight and mass, as Well .as having suchinsert portion uniquely contoured to adapt underlay of gauze pads in awrinkle free condition while the top surface of the instrument serves asdrainage for fluid discharge.

Yet another object of the invention is to provide an instrument for useduring episiotomy which will take a United States Patent 2 ,829,649Patented Apr. 8, 1958 firm and stable lodgment by the simple act ofinsertion and which will effect hemostatically a dry field and clearvisual range to the attending surgeon for the purpose of enabling promptattention to inspection and vaginal repair.

The foregoing and other objects and purposes of the invention will bemore detailedly described during the course of the followingexplanation, having reference to the accompanying drawings in both ofwhich like reference numerals designate corresponding parts throughout,and in which:

Fig. 1 is a fragmentary longitudinal sectional view through a femalebody reproduction organs representing conditions following delivery andsecond stage of labor, with a retractor designed in accordance with thepresent invention disposed therein;

Fig. 2 is a fragmentary elevational view which illustrates by dottedline indication the alternative locations of episiotomy incisions;

Fig. 3 is a sectional view similar to Fig. l, but illustrating the birthcanal under full dilation and with the perineal wall under distension aswhere relief by episiotomy is indicated;

Fig. 4 is 'a perspective view of a retractor in accordance with thepresent invention;

Fig. 5 is a side elevational view of the retractor with parts thereof insect-ion;

Fig. 6 is a front elevational view of the same;

Fig. 7 is a fragmentary plan view of the retractor insert portion, and

Fig. 8 is a fragmentary view resembling Fig. 5 but of a modifiedvariation of the retractor-hemostat handle portion.

During the second stage of labor, when the fetus has passed into thepelvic cavity, as represented in Fig. 3, a surgical procedure isofttimes advised, particularly in the case of primaparae, which involvesradially incising the perineal wall along the index line 11 or along amediolateral line such as at 12. This permits the head of the fetus 13to protrude promptly through the vulva to a greater extent as well asrelieving the strain which had been impressed upon the perineum 14.Also, it facilitates the descent and extension of the fetus through theensuing phases of the delivery.

The compression upon the surrounding vulval wall during the occupationof its opening by the fetus does .itself act as a tamponade to retardloss of blood for this interim, but after delivery is complete the wallarea becomes relaxed and blood flow through the incision becomesimminent. Repairing the incision at once would, of course, arrest thisblood loss, but at the expense of again restricting the size of thevulval aperture and sacrificing one of the paramount advantages ofepisiotomy, greater access to the vaginal interior, mucosa membrane etc.where inspection and repair are frequently necessary.

The problem, therefore, is one of keeping the episiotomy open withoutincurring undue loss of blood to the patient. The importance of avertingexcessive blood loss cannot be overemphasized. It is recognized bymedical authori ties as a chief cause of maternal fatalities during andfollowing childbirth. From a study made of clinical reports during theyears 1930 to 1942 in the United States, and based upon U. S. Bureau ofthe Census statistics, puerperal infection accounted .for 36% ofmaternal mortality, toxemia 26% and hemorrhage 28%. Since the loss ofblood directly contributes to depletion of resistance with which tocombat both infection and toxemia, it therefore is a large predisposingfactor to both of these causes and thus, manifestly is responsible forpossibly up to three-fourths of all maternal deaths which result fromchildbirth.

It is the purpose of this invention to diminish the additional bloodloss resulting from episiotomy, which loss is known to vary in averagecases from to 397 millilitersper patient. By reducing this loss to aninsignificant level there should follow a material reduction offatalities attributable to the enumerated causes above. This pur-.pose'has been recognized and strived for before, and clinicians haveendeavored to clamp and ligate bleeding vessels in other ways, but thetime occupied and the inefficiency of other procedures have resulted inlittle benefit, for while the amount of blood lost per minute duringexposure has been reduced, the period of bleeding was increased due tothe time consumed in such procedures.

-.Stufling a sponge into the wound has been found to soak up the bloodso that the loss was not so much in evidence, but as a relief measurethis practice only createdan illusion of correction.

A marked increase of blood loss after delivery is believed-to beinducedby changes in the venous'circulation when various congestions becomerelieved. It is therefore 'allthe more important to be able to check theloss during this phase of the delivery and before any episiotomy repaircan be undertaken. As soon as the actual delivery is made and evenbefore the umbilical cord is severed, the technician places into theepisiotomy breach a substantially weighted semi-cylindrical insertportion of a device such as portrayed in Figs. 4 or 8, after havingfirst laid over the wound one or two layers of sterile gauze. The insertportion or body 16 is a highly polished part-cylindrical solid memberabout three and one half inches in length and having a major transversediameter of about one and seven eights inches. Its Weight should bebetween eighteen and twenty ounces whereunder it has been found to exerta suitable hemostatic compression upon the severed blood vessels of theepisiotomy to etfectively restrain the free flow of blood.

The foremost end of the instrument body 16 is advantageously undercut asat 17 to allow a clearance or bridgment for possible displacementaccumulations between the mucosa, intercolumnar fascia, and the perinealsections which, following the delivery, may assume displacement andshifting variations on account of the contractions which beginimmediately to take place. This bridgment permits the trough-like topportion 19 to extend over such displacements 24 without becomingdisturbed and assures continuous drainage to take place as well asprovide for a clear visual observation range.

The insert body 16 is formed with a slightly reentrant quadrant junctureblending into the trough handle 18 which, in contrast with body 16, isof thin attenuated stock, continuously channeled to carry the drainagefeature throughout its length downwardly. The convex surface of thehandle is by filleting as at 20, smoothly blended with the adjacentpart-cylindrical outer surface of the insert portion. Thus, thercentrant juncture permits the trough handle to repose within theperineurial hollow, out of conflict with possible inspection and repairoperations.

In Fig. 8 there is taught a variation of the trough handle design which,while adhering to the reentrant curvature feature of the preferredembodiment, provides nevertheless for an anus region otfset designated23 which is a precaution against possible contamination of theinstrument by fecal seepage during the delivery.

The handle may also include a bulbous intermediate section 21 which canbe finger controlled by thus graspihgthreat for etfecting retraction.The extremity of the handle 18 is advantageously underslung as at 22 toassure a more positive grip and to assist traction. The weight of thehandle portion 18 is preferably about one tenth that of the insertportion 16, so that the stability of the instrument when lodged in theepisiotomy breach, as shown in Fig. l, is thereby made more secure onaccount of the gravitational preponderance.

While the surgeon awaits expulsion of the placenta 27, denotingcompletion of the final stage of labor, a period of timemay elapse whichin some cases exceeds an hour and. during which there normally may occurfli i l of blood to endanger the patient. The instant invention whenutilized in the manner explained will promptly arrest this bleeding byhemostatically compressing the exposed blood vessels and permit thesurgeon to proceed without delay to make the interim inspections andrepairs to the canal walls where passage of the fetus or other causesfrequently results in surface lesions and abrasions. Thus, theimprovement enables the arrest of blood loss due to these surfacedamages in a more prompt and expeditious manner.

Meanwhile, the hemostat-retractor reposes sheltered and seeure'in itssubmerged position, promoting continuous drainage of the dischargefluids and assuring a clear range of view to the operator. Whenadditional retraction is required, an assistant need only grasp theinstrument handle and apply the additional force. This is a one handedmanipulation, permitting the other hand of the assistant to be used foranterior retraction in the conventional manner as with a tool such asindicated 25, Fig. 1. Thereafter the improved instrument may be reliedupon to maintain-itself in its placement on account of its severalfeatures of self-retentivity pertaining to weight resolution andcontour. Contour retentivity is augmented by the encompassment of itspart-cylindrical insert body portion by the wall muscles which withcompletion of the delivery, undergo contraction.

-As a consequence, one hand of the operative assistant which ordinarilyis required to maintain the posterior retractor becomes freed for otherwork, such as assisting in suture making or sponging. This eflicieney isof great importance to the success of the delivery because 'the problemof providing necessary assistance to the surgeon is aggravated largelyby the limited theater surrounding the patient while in the deliveryposition.

Employment of gauze layers in the manner explained, is advised becausenot only do the fabric filaments aid in establishing more promptly adesirable surface clotting condition, but also such condition isreinforced and made to survive even against relative movement ofadjacent parts to the incision. Thereafter, when the wound is to beclosed, the operator by lifting off the gauze layers, removes theclotted blood as well, and is at once able to proceed with applying thesutures.

While the present invention has been explained and described withreference to illustrated examples of embodiment, it should be understoodnevertheless that various modifications and alterations are susceptibleof being made without departing from its essential spirit or scope.Accordingly, it is not intended to be limited by the preuse language ofthe foregoing description nor by the illustrations of the accompanyingdrawings, except as indicated in the hereinafter appended claims.

The invention claimed is:

1. Am episiotomy hemostat and retractor instrument comprising anintegral metallic unit having a massive insert portion and a relativelythin attenuated handle continuous channel portion, said insert portionincluding a solid part-cylindrical outer body surface and having aforemost end curvedly undercut to form a bridgcment and a top surfacecontinuous trough curvature therein, said handle portion constituting anabruptly attenuated continuation at the rear end of said insert portion,and a quadrant juncture portion merging with the trough curvature topsurface of said insert portion and the curvature of said handle portion.2. The combination set forth in claim 1 in which said insert portion isbetween eight and twelve times the weight of said handle portion,whereby during placement of said insert portion into an episiotomybreach, the gravitational preponderance of said insert portion preventsaccidental dislodgment of said retractor.

' 3. The combination set forth in claim 1 in which said quadrantjuncture portion describes an angle cxceedmg' ninety degrees whereby toform a slightly reentrant slope to said handle portion for the purposeof disposing said handle portion protectively within the perineurialconcavity of a patient to avoid obtrusion.

4. The combination set forth in claim 3 in which said handle portionconstitutes a reentrant section extending from said quadrant junctureportion for a distance of 5 about three quarters inch, then reverses ata relatively sharp curvature downward and outward for about an inch, andthen curves reentrantly again to conform with the first mentionedreentrant section, whereby to provide a displacement to said handleportion at the proximity of 10 the patients anus whilst said insertportion is in utility position.

References Cited in the file of this patent UNITED STATES PATENTS516,842 Scheerer Mar. 20, 1894 659,182 Pilling Oct. 2, 1900 2,666,428Glenner Jan. 19, 1954

